Recent advances in post-kala-azar dermal leishmaniasis
Dinesh Mondal1, Md Gulam Musawwir Khan
1International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. din63d@icddrb.org
Current Opinion in Infectious Diseases
|September 3, 2011
Summary
Post-kala-azar dermal leishmaniasis (PKDL) diagnosis and treatment have advanced, with miltefosine showing high efficacy. Further research into combination therapy for PKDL is recommended to improve patient compliance.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Post-kala-azar dermal leishmaniasis (PKDL) presents diagnostic and treatment challenges.
- Understanding PKDL pathogenesis is evolving, particularly its link to host immunity.
- Recent research offers insights into improving PKDL diagnosis and management.
Purpose of the Study:
- To review recent advancements in PKDL diagnosis.
- To explore new insights into PKDL pathogenesis.
- To discuss current PKDL case management strategies.
Main Methods:
- Literature review of recent studies on PKDL.
- Analysis of data on PKDL burden and clinical forms.
- Evaluation of diagnostic techniques, including PCR for Leishmania DNA.
- Assessment of antileishmanial drug efficacy and immune response.
Main Results:
- PKDL burden data, especially from Bangladesh, is now available.
- Skin parasite burden correlates with PKDL clinical forms (nodular/papular vs. macular).
- PCR detection of Leishmania DNA in blood and skin aids diagnosis in 40-75% of suspected cases.
- Miltefosine demonstrates high efficacy (95% initial cure rate) for PKDL treatment.
Conclusions:
- PKDL incidence is decreasing in India but remains high in Bangladesh and Sudan.
- Miltefosine and amphotericin B have reduced PKDL incidence in India.
- Combination therapy for PKDL warrants further investigation to shorten treatment duration and improve compliance.
